The incidence of gastro-jejunal ulcer following gastroenterostomy

Summary

The above cases have been presented in detail so as to give a complete clinical picture of each case and one can note that of the 13 cases we are reporting, five were operated upon in hospitals in or around New York and eight were operated upon at Bellevue Hospital, and of the 13 cases no two patients were operated upon by the same surgeon. From the review of our cases we feel that any conclusions drawn as to the percentage of gastro-jejunal ulcers developing after gastroenterostomy is most inaccurate unless the patient has been followed for a 10-year period, and also seen at frequent intervals, with repeated X-ray examinations. A follow-up letter in stomach cases is not only inaccurate but misleading and instead of being a help usually presents false information. It is seen that three of our cases that came to operation developed their symptoms of a marginal ulcer after seven years, one being ten and a half years following gastroenterostomy.

When one realizes that the great majority of our patients have been followed less than five years and in 79 gastroenterostomies we have encountered 13 gastrojejunal ulcers, or 16.4 per cent, and of the 13 cases three occurred after seven years, it would seem that 10-year follow-up is necessary in drawing conclusions as to the per cent of gastro-jejunal ulcers.

It is important to emphasize that gastro-jejunal ulcers run, to a great extent, the same course that do a peptic ulcer that is they have pain with periodicity, and freedom from symptoms for intervals of weeks or months which is one reason why the flare-ups that are occasionally seen in post-operated cases are passed over lightly if X-ray examinations have not been taken. Our cases have also illustrated that too much dependance cannot be placed upon a negative gastro-intestinal examination and patients frequently will have a marginal ulcer in spite of several negative gastro-intestinal series.

Medical treatment should be tried for as long a period as the patient progresses satisfactorily because marginal ulcers will get symptomatic relief from conservative treatment the same as will any peptic ulcer. If the patient continues to have severe pain under medical treatment it usually means the marginal ulcer is perforating into some adjacent viscus and the pancreas and transverse colon are the organs most usually involved. For that reason it is best to submit a patient with a gastro-jejunal ulcer suffering severe pain to a second operation, rather than continue medical treatment, if the pain is not relieved or improved rather promptly under conservative treatment.